Organization
IDP PUNXSUTAWNEY LLC
Active
Other names
John Regis Smelko
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JULIE SMITH (OPERATIONS FACILITATOR)
(231) 739-5105
Entity
Organization
Contact information
Practice address
219 N MAIN ST, PUNXSUTAWNEY, PA 15767-1217
(814) 938-2222
(814) 938-0931
Mailing address
219 N MAIN ST, PUNXSUTAWNEY, PA 15767-1217
(814) 938-2222
(814) 938-0931
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS018913L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006936660001
—
PA
Enumeration date
07/29/2013
Last updated
07/29/2013
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